Article Text
PDF
Abstract
Introduction Acoustic radiation force impulse elastography (ARFI) and Transient elastography (TE) are noninvasive methods of measuring liver stiffness (LS) and spleen stiffness (SS). They were proposed as non-invasive predictors of portal hypertension in patients with HCV-related cirrhosis, a highly prevalent disease in Egypt. This is the first egyptian study aimed to validate the reliability of liver and spleen stiffness measured by ARFI and other non-invasive methods as non-invasive predictors for presence of esophageal varices (EV).
Methods This cross-sectional study included 200 patients (mean age was 54.9±8 years) with HCV-related advanced fibrosis (METAVIR score ≥F3) diagnosed by FibroScan® (≥ 9.5 kilopascal) including Child Turcotte Pugh class A/B liver cirrhosis; 82/18%. Demographic, clinical, biochemical, endoscopic and ultrasonographic data were collected. LOK index and FIB-4 score were calculated. Liver and spleen stiffness were assessed by 10 ARFI measurements, both in the liver and in the spleen; median values were calculated, expressed in m/sec. The accuracy of these diagnostic methods in diagnosing EV was evaluated on the basis of area under receiver operating characteristic (AUROC) curves.
Results Liver stiffness measurement by FibroScan® revealed F4 in 95.5% and esophageal varices were present in 90 patients (39 Grade I, 30 Grade II, 18 Grade III, 3 Grade IV). Spleen longitudinal diameter (cutoff value 14.85 cm), splenic vein diameter(cutoff value 7.9 mm); platelets to spleen diameter ratio (cutoff value 960), LOK index (cutoff value 0.62)and FIB-4 score (cutoff value 2.81) were the best parameters among all the ultrasonographic and biochemical parameters for prediction of esophageal varices; AUROC 0.79, 0.76, 0.76, 0.74 and 0.71, respectively. Using ARFI, SS had better diagnostic performance than LS with cutoff value of 3.25 m/sec and 2.61 m/sec; AUROC =0.76 and 0.70, respectively. Moreover, the calculation of simple prediction models including LS and/or SS improved the reliability of ARFI for the prediction of esophageal varices; (Spleen longitudinal diameter × Splenic vein diameter × SS) and (LS× SS / Platelets/Spleen diameter ratio) with AUROC = 0.85 and 0.83 respectively.
Conclusion Liver stiffness and spleen stiffness represent a non-invasive reliable tool for the prediction of clinically significant portal hypertension as evident by the presence of esophageal varices in chronic liver disease patients.
Disclosure of Interest M. Abdelbary: None Declared, S. Kamal, None Declared, A. Albuhairi: None Declared, A. Khairy Grant/research support from: ABBVIE, Speaker bureau with: Astra Zeneca, N. Zayed Grant/research support from: ABBVIE, A. Yosry Consultant for: Roche, Janssen, Gilead, MSD, Speaker bureau with: Roche, Janssen, Gilead, MSD